The Jeff Smith Time-Out: It is NOT a Checklist!

The term "Time-Out" means different things to different people, but to Surgeons it means something specific. 

Surgical Time-Out

Personally, I'm not a fan of the "surgical time-out."

It's not because I'm uninterested in patient safety or the avoidance of wrong-site surgery--It's just I've rarely felt that Surgical time-outs increase my team's quality of care or patient safety. 

To date, I have never had a wrong site surgery (knock on wood) and the current surgical time-outs will NOT help me avoid having one. 

OK, let me back up a little...

There was a time I wasn't totally against the time-out.

In the early years of the surgical time-out, things were simple; it was the final confirmation that we were operating on the left or right side of the patient. That was it.

Did wrong site surgery problems completely go away? No. But a team focus to help us better avoid the most tragic surgical errors is very well intentioned.

The Problem with Checklists

The problem I have is that we have added everything critical to the surgical time-out to create Checklists!

Guess what? From a surgeon's viewpoint, most everything in the operation is critical.

Keep in mind that many surgeons are overworked and are being asked to carry heavier and heavier clerical burdens even just before operations that require us to be “on our game!” 

The time out is just one MORE thing that many surgeons consider a burden and a distraction from our performing at our best.

Unfortunately, reversing this trend of checklists and multifaceted time-outs might be impossible, even though there has been minimal evidence to suggest these measures have lowered the incidence of wrong-site surgery or improved patient safety.

But what if we as surgeons looked at the "Time-Out" through a lens of opportunity?  

What if we let our team do whatever they are required to do during the time-out? 

What if we then CHOSE to do whatever WE need?

For me, I now CHOOSE to use the time-out to privately calm my frustrations and stresses from the pre-op hassles. I also make the final confirmation of patient identity and surgical site.

What will you CHOOSE to do?

P.S. Check out my friend Philip Stahel’s new book Blood, Sweat and Tears: Becoming a Better Surgeon Chapter 16 for a different perspective on the surgical time-out.

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